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FAMILY FARE PHARMACY #1904
FQHC638522B NHBP Health Department
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Covered Entity Details
Entity Name
NHBP Health Department
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638522B
Entity Address
311 State Street
Grand Rapids, MI 49503
Grant Number
Participating Start Date
1/1/2017
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
FAMILY FARE PHARMACY #1904
Pharmacy Address
45 COLUMBIA AVE
BATTLE CREEK, MI 49015-3373
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen W. Blann, Chief Financial Officer
(269) 729-5151 Ext: 8389
Contract Pharmacy Representative
SpartanNash
Eddie Garcia, Director of Pharmacy
(616) 878-2975
Signed By Date
10/14/2016
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